Artritis seudoséptica presenta sinovitis por cuerpo extraño en un paciente con gota / Pseudoseptic arthritis with foreign body synovitis in a patient with gout

La monoartritis es un reto diagnóstico para el clínico, ya que es extensa la lista de patologías asociadas. En pacientes con diagnóstico establecido de enfermedad articular inflamatoria, se acepta que la monoartritis corresponde a la exacerbación de la enfermedad de base; sin embargo, ignorar el abordaje sistematizado de las monoartritis puede generar omisiones e implicaciones diagnósticas erróneas. En este reporte se analiza el abordaje de un caso de artritis seudoséptica, simulando un ataque agudo de artritis por urato monosódico recurrente en un paciente con retención de cuerpo extraño intraarticular.

Monoarthritis is a diagnostic challenge for the clinician, as the list of associated conditions is quite long. It is accepted that in patients with a diagnosis of inflammatory joint disease monoarthritis represents exacerbation of the underlying disease. However, ignoring the systematized approach to monoarthritides may lead to omissions and mistaken diagnostic implications. This report describes the approach to a case of pseudoseptic arthritis that mimicked an acute episode of recurrent arthritis due to monosodium urate in a patient with retention of an intraarticular foreign body.

Silicon Dioxide Particles Deposited in Vessels and Cartilage of the Femoral Head

Silicosis had been considered for decades as an illness with manifestations of lung fibrosis due to inhalation of overconcentrated SiO2 dust. To the best of our knowledge, studies have yet to report SiO2 deposits in any other tissues and organs. In the present case, while performing bilateral artificial total hip arthroplasty for one patient, we found that the articular cartilage of the bilateral femoral head was black. Therefore, specimens thereof were sent for pathological examination. Pathological examination (immunohistochemistry) and polarized light microscopy revealed the presence of considerable brown, acicular, rhombic, and crumb-like crystals. The crystals were mainly composed of SiO2. SiO2 could deposit in vessels and femoral head cartilage via blood circulation.

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.

Sinovite proliferativa crônica da articulação metacarpofalangiana em equinos: relato de caso / Chronic proliferative synovitis of the fetlock joint in horses: case report

Uma potra da raça Mangalarga foi avaliada clinicamente por apresentar claudicação dos membros torácicos. À inspeção, observaram-se desvios angulares e sensibilidade em ambos os membros, especialmente o esquerdo, que se mostrava sensível à flexão da articulação metacarpofalangiana. Ao exame radiográfico, visualizaram-se imagens compatíveis com sinovite proliferativa crônica da articulação metacarpofalangiana esquerda. A artrografia contrastada positiva confirmou a presença de massa tecidual ocupando a superfície dorsoproximal da articulação. Pela severidade da lesão, realizou-se artrotomia metacarpofalangiana esquerda. Neste caso, optou-se pela remoção do processo proliferativo, que produzia reabsorção óssea de grande intensidade e redução da cortical da epífise distal do metacarpo III, com risco de fratura patológica.

A Mangalarga foal was examined presenting both front limb lameness. The clinical examination revealed angular limb deformity and increased pain sensation, notably on the front left limb, which showed a reduced range of motion on the metacarpophalangeal joint. X-ray images indicated chronic proliferative synovitis in the above mentioned joint. Positive contrast arthrography confirmed a space occupying mass on the dorsoproximal surface of the joint. Due to the severity of the lesion, arthrostomy was performed followed by the removal of the proliferative tissue, to reduce the risk of pathological fracture on the distal end of the metacarpus III.

Diseño de un nuevo rasurador/coagulador atroscópico para sinovial con aplicación de corrientes de alta frecuencia. Reporte del sangrado postoperatorio de 20 sinovectomías comparativas / Design of a the new athroscopic razor-coagulator for sinovial surgery with coagulating high frecuency current application. Comparative postoperative bleeding between arthroscopic and open synovectomy

Se presenta un instrumento para empleo artroscópico que sirve fundamentalmente como rasurador y que al mismo tiempo funciona como coagulador puesto que el borde de la navaja rotatoria se encuentra electrificado. Se operaron 20 pacientes, 10 del grupo A para sivectomía artroscópica y 10 del grupo B de sivectomía abierta de la rodilla. El drenaje postoperatorio recolectó en promedio 5 ml de sangre para el grupo A y 454 ml para el grupo B. El comportamiento postoperatorio fue similar para ambos casos

Epidemiology of perthes' disease in bahrain: no relationship to transient synovitis

A review of 91 patients with a discharge diagnosis of transient synovitis of the hip [TSH] from 1987 till 1995, none developed clinically overt perthes disease. No total hip arthroplasty has been performed to date for osteoarthritis secondary to perthes' disease. These facts lend support to the changing precept that there exists little relationship between perthes' disease and TSH. Hence, we see no reason for aspiration of the irritable hip exclusion of septic artritis. Radiographic follow-up of patients presenting with a single episode of transient synovitis of the hip is also unnecessary

Assessment of inflammation in the rheumatoid knee joint: correlation between clinical, laboratory and thermographic methods

The present study was done to evaluate the role of thermography in assessment of inflammation in rheumatoid knee patient. Also, a trial to find a correlation between thermographic index and disease activity. The subjects of this study included thirty patients suffering of rheumatoid arthritis [24 females and 6 males]. They are selected from the outpatient clinic of Rheumatology and Rehabilitation Department at Zagazig University Hospital, and diagnosed according to American Rheumation Association, revised criteria [Arnett et al., 1988]. Their ages ranged from 23 - 55 years, with a mean [37.7 +/- 11.28] years and the disease duration ranged from 7 months - 8 years with mean [3.4 +/- 1.3 years]. All of these patients suffer from active synovitis of one or both knee. Ten healthy individuals [4 males and 6 females], were chosen as control for thermography. From the study we found abnormal thermal pattern in the knee of rheumatoid patients as they were in activity. Also, we found a highly significant correlation between thermographic index and mean disease activity grades [Mallya score [P < 0.001]. Thermography was found to be an objective method for measuring the degree of inflammation in different joints of RA. It was simple, sensetive, safe, reproducible and capable of monitoring changes in disease activity over time

Role of histopathology in the diagnosis of tuberculous synovitis.

A study was conducted on 70 cases of tuberculous synovitis. Maximum number of cases were in the age group of 11-30 years (58.58%) with a male preponderance. Knee joint was found to be most commonly (57.12%) affected. Diagnosis of tuberculous synovitis was possible clinically in 75.72% and radiologically in 67.14% of cases only. Histopathological studies made on biopsy materials obtained from synovial membranes of the affected joints showed the presence of fibrosis, lymphocytic infiltration and epithelioid cells forming typical granuloma of tuberculous lesion. Proliferation of synovial membrane (92.85%), increased number of mast cells (82.95%) and caseation (78.57%) were observed. In all the cases the synovial membrane was of greyish white appearance.

Resonancia magnética de la rodilla / MRI of the Knee

Los autores analizan en forma breve los procesos patológicos mas frecuentes de cada una de las estructuras intra y periarticulares de la rodilla y su comportamiento en las diferentes adquisiciones, así como alteraciones en las estructuras óseas de tipo traumático, infeccioso y tumoral.

Síndrome de RS3PE

La sinovitis simétrica seronegativa remitente con edema blando (Síndorme R S3 P E por las iniciales en ingles) constituye una forma diferente de artritis que se observa en personas de edad, generalmente mayores de 60 años y se caracteriza por tener pronóstico excelente a pesar de iniciarse en forma aguda e incapacitante en la mayoría de los casos. Se presenta el resumen de dos historias que reunen los criterios clínicos establecidos para esta entidad.

Differential diagnosis of acute arthritis in children: analysis of 126 cases in Kuwait

In this retrospective study of 126 children with acute arthritis admitted to Mubarak Al-Kabeer Hospital over a 2-year period, diagnoses were viral-related arthritis in 26%, sepsis 16%, rheumatic fever 15%, transient hip synovitis 13%, connective tissue disease 11%, Henoch-Schoenlein purpura 8% and other diagnoses 14%. This pattern is more representative of general hospitals than rheumatology clinics. Polyarthritis patients did not represent a medical emergency or diagnostic difficulties. In 74 children who presented with monoarthritis, 64 were admitted as possible sepsis, proven in only 20 cases. Familial Medi terranean fever and brucella arthritis presented special problems of differential diagnosis; the most helpful findings were ill health, high fever, point tenderness and positive C-reac tive protein. Neutrophil leucocytosis and high erythrocyte sedimentation rate were not as helpful

Sinovite vilonodular pigmentada: apresentaçäo de um caso / Pigmented villonodular synovitis: report of a case

Os autores apresentam um caso de sinovite vilonodular pigmentada que comprometeu o joelho esquerdo. Um aspecto importante foi o näo comprometimento ósseo, ou seja, a ausência de erosäo subcondral e lesöes císticas